Posts Tagged ‘1% hydrocortisone’

Should You Treat Eczema With Steroids?

Wednesday, April 25th, 2012

When my son developed eczema, we had been seeing a naturopath for his well-baby check-ups. Once we were sure he had eczema, she began to try different things to try to bring relief. She said we could use a little .5% hydrocortisone as needed, but to use it sparingly. She also discouraged us from using steroid cream of any kind, because, according to her, suppressing the reaction could make it go other places, such as the lungs, and cause other problems. Plus I had heard all kinds of stories, such as the eczema coming back worse when the steroids were done, and I was afraid that it would suppress the reactions so much that I wouldn’t be able to see when he was reacting to a new food.

At first, this arrangement worked okay. Because his eczema didn’t start with a bang, but built up gradually. However, I watched with increasing discouragement as it spread, starting with his face, then down his torso, and finally down his arms and legs. At the worst point, it was everywhere except for his hands and feet, but beginning to encroach on them.

By the time he was nine months old, I was a nervous wreck. I could barely function as wife and mother. Cleaning house was overwhelming. I just wanted to escape my problems, and there were times I would let him cry in the back room while I tried to cope by watching a movie or playing some game online. Going back to get him would just rind me of my helplessness to do anything for him, and it was more than I could take.

We decided that we needed to move closer to my husband’s work, and with the move came the decision to find a new doctor. We had reached our limit for alternative care with the insurance company, and naturopaths are expensive–not to mention that most of their treatments are not covered by insurance. A little research turned up Dr. Paul Thomas, a pediatrician who liked to integrate natural methods into his practice as much as possible.

One of the first things he did was encourage us to use more hydrocortisone. And I was to the point where I just couldn’t deal with the eczema anymore, so I started using it generously wherever he seemed irritated. I also started using 1% on his body and .5% on his face. We found ourselves spending $20 a month or more on this over-the-counter cream, but it helped. His face stopped weeping, and he became a happy baby again. Sure, he still reacted to food and scratched a lot, but he didn’t start rubbing his face in the carpet every time I put him down to learn to crawl.

We continued this regime for about a year, taking different tests and trying a few things the doctor recommended. When he was about a year and a half old, the doctor asked me if I would like to try a stronger steroid cream, just to help alleviate the symptoms a little more. This was the second time he had suggested this, and I decided to try it.

So for the next nine months, we used Triamcinalon, a medium-level steroid cream. And I learned some things during this time that I wish I had known when my son was younger.

  • A topical steroid only treats the current irritation; it does not prevent new reactions.
  • There are several levels of steroids; they are not all the same.
  • Eczema is most likely to break out on already irritated skin.
  • Stronger steroids should not be the first line of defense, nor the only treatment.

Let us look at these more closely.

Topical steroids do not prevent breakouts. I was under the false impression that if I used a stronger steroid than hydrocortisone, that if I cleared his skin up with steroids, then I wouldn’t be able to tell what foods he was reacting to. Nothing could have been further from the truth. Sure, if I had been giving him oral steroids, this might have been the case (I will discuss oral steroids in a future post). But a topical steroid cream or ointment only treats current symptoms. It does nothing to prevent an outbreak. So I could still see when he was reacting to foods, depending on the severity of the allergy and the amount of food consumed.

Not all steroids are created equal. When we visited an allergist,I learned something about steroids that the no-steroid advocates had failed to mention: there are various levels of steroids. Hydrocortisone is the weakest steroid, and the difference between .5% and 1% is the concentration of the drug, not a different drug. We even used 2.5% hydrocortisone for a while–this was only available with a prescription. Triamcinalon is a medium level steroid. There are 5-7 levels, depending on whom you ask, and most doctors will prescribe the lowest level that gets results.

Eczema tends to show up on already irritated skin. So many mothers and natural doctors on the Internet were saying to avoid steroids at all cost, but after I started using hydrocortisone more liberally, I realized that he was much more likely to have a reaction on already irritated skin than he was to break out on healthy skin. As his skin healed, the irritation reduced from basically all over to select spots here and there. As a result, I was able to use less steroid cream, because I didn’t need to use it all over, but only on the irritated areas. At this point, a good moisturizing routine began to really help too. It hadn’t made much difference back when he was at his worst.

Not first line of defense, nor only treatment. If someone develops eczema, using steroids should not be the first line of defense, nor should it be the only treatment. Not that you shouldn’t use a little hydrocortisone as needed (and you definitely should moisturize–sometimes that is all that is needed), but rushing out to get a strong steroid prescription right at first is probably not a good idea. You need to take a look at possible causes. In some cases, cutting a particular food out of the diet or getting rid of all chemical cleaners in the home will clear up the problem. In other cases, such as my son’s, the root of the problem is very deep and obscure. Most doctors in traditional practice are content with controlling the symptoms and never bother to look for the cause. That is why we keep going back to a naturopath: we are gradually identifying the cause and we are seeing results to such an extent that we haven’t needed the medium-level steroid cream for over a year. But I’m glad we used it when we needed it.

In summary, I do not believe that steroids should be avoided at all costs. I believe that the lowest level may be used to treat symptoms while the cause is being searched for. I also believe that topical steroids are a better choice for treatment of symptoms than oral steroids, though oral may be needed temporarily in a very severe case. Treating the symptoms will not cure the eczema, but it will make life bearable while the root cause is being sought out. Because “the curse causeless shall not come” (Proverbs 26:2); there is a cause for every disease, though it may not be readily discernible.

What has been your experience with steroids? Have you avoided them entirely? Used them liberally? Somewhere in between or back and forth? Please share your experience in the comments.